MEDICARE: MRS. CHRISTINE RICH RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	9266611	FL

General Provider Information

NPI Number	:	1912464306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHRISTINE RICH RN

Provider Business Mailing Address
First Line	:	160 PETTY CIR
Second Line	:
City	:	TITUSVILLE
State	:	FL
Zip	:	32796-3276
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	160 PETTY CIR
Second Line	:
City	:	TITUSVILLE
State	:	FL
Zip	:	32796-3276
Country	:	US
Telephone Number	:	321-480-4412
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2019
Last Update Date	:	02/21/2019

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